摘要
背景我国订单定向医学生免费培养项目(简称订单定向项目)政策从建设基层医疗卫生人才队伍入手,为提高我国农村地区的医疗服务可及性和医疗服务质量等做出了卓越贡献。综合了解订单定向医学生队伍现状,对评价该项免费培养政策的执行效果,以及基层医疗卫生人才队伍的长期发展有重要意义。目的对我国订单定向项目相关研究及国外相似项目研究进展进行综述,归纳总结项目的执行过程和执行结果,并比较国内外研究的异同。方法本研究开展时间为2021年7—9月。在中国知网、万方数据知识服务平台、维普网进行中文文献检索,检索时间设定为2010-07-01至2021-07-01;在PubMed、Web of Science、Scopus进行英文文献检索,检索时间设定为2000-01-01至2021-07-01。根据纳入与排除标准进行文献筛选,提取相关信息,根据研究对象和研究内容对文献进行分类分析。结果最终纳入文献443篇,其中关于我国订单定向项目的文献427篇,关于国外相似项目的文献16篇。纳入文献的研究主题包括培养方式、招生录取、培养过程、就业发展4大类。在427篇我国订单定向项目相关文献中,102篇(23.9%)对订单定向医学生培养方式进行论述。10篇(2.3%)对订单定向医学生招生录取情况进行分析,发现订单定向医学生对相关政策的知晓率较高(>75.0%~90.9%),农村生源比例较高(57.6%~84.2%)。270篇(63.2%)文献以订单定向医学生的培养过程为切入点,重点对其学习情况、职业认同感和履约意愿进行研究,发现订单定向医学生学习成绩和职业认同感低于普通临床医学生。对订单定向医学生履约意愿的研究结果差异较大(42.4%~98.4%),依据样本量加权得到平均履约意愿为66.2%。仅有25篇(5.9%)对订单定向毕业生就业发展情况进行研究,发现其平均履约率为93.6%。与其他临床五年制毕业生相比,订单定向医学生完成住院医师规范化培训和通过执业医师考试的进程较快。在纳入的16篇国外相关文献中,11篇(68.8%)对订单定向医学毕业生的就业发展情况进行了研究,得到的结果与国内研究相似。结论目前订单定向研究数量较多,主题丰富,研究发现订单定向医学生免费培养政策执行较好,为中西部地区培养了大量优秀的基层卫生人才。但目前研究多着眼于订单定向医学生的培养阶段,对于已投身基层的医学生了解不足。未来研究应将重点放在订单定向医学生完成合同期后的留任情况、就业后的职业发展进程及在基层医疗卫生机构中发挥的实际作用3个方面。
Background Our state policy of free training of compulsory rural service oriented medical students(abbreviated as rural service orientation project)starts with the construction of a team of primary medical health talents and makes an excellent contribution to improve the accessibility and quality of medical services in rural areas of China.A comprehensive understanding of the current state of the rural service directed medical student team is important to evaluate the implementation effect of the free training policy,as well as the long-term development of the primary care health talent team.Objective To review the research progress of related studies on rural service orientation project in China and similar projects abroad,summarize the execution process and execution results of the projects inductively,and compare the similarities and differences between domestic and foreign studies.Methods The study was conducted from July to September 2021.A literature search for Chinese language was conducted in CNKI,Wanfang Data Knowledge Service Platform and VIP,and the search time was set from 2010-07-01 to 2021-07-01.A literature search in English was conducted in PubMed,web of science,Scopus,and the search time was set from 2000-01-01 to 2021-07-01.Literature screening was performed according to the inclusion and exclusion criteria,relevant information was extracted,and the literature was classified and analyzed according to the subjects and contents of the studies.Results A total of 443 articles were finally included,with 427 of them on our rural service orientation project in China and the rest 16 on similar projects abroad.The research topics that were studied in the literature included four broad categories:cultivation mode,enrollment,training process,and employment development.In 427 related literatures of China's rural service orientation project:102(23.9%)discussed the training mode of rural service oriented project.Ten(2.3%)analyzed the admission status of rural service directed medical students and found that rural service directed medical students had higher awareness rate of the related policies(>75.0%-90.9%)and the proportion of rural students sources was higher(57.6%-84.2%).270(63.2%)literatures used the cultivation process of rural service directed medical students as a starting point and focused on their learning situation,professional identification and performance willingness,and found that rural service directed medical students had lower academic performance and professional recognition than general clinical medical students.The results of studies on the performance willingness of rural service directed medical students varied greatly(42.4%-98.4%),and the average performance willingness was 66.2%when weighted by sample size.Only 25(5.9%)studied employment development in rural service orientated graduates and found an average performance rate of 93.6%.Rural service directed medical students had a faster rate of completing standardized residency training and passing practitioner examination than other five-year clinical graduates.Of the 16 foreign related literatures included,11(68.8%)examined the employment development of rural service directed medical graduates and obtained results similar to those of domestic studies.Conclusion A larger number of current studies focused on rural service oriented project and had rich topics.It was found that the rural service directed free medical student training policy was better implemented,leading to a large number of excellent primary health talents in the Midwest.However,most of the current research focuses on the cultivation stage of rural service oriented medical students,and there is insufficient understanding of medical students who have joined the primary care team at elementary level.Future research should focus on three aspects:performance status after rural service directed medical students having completed the contract period,career development process after employment and the actual role they play in primary health care institutions.
作者
张柏松
胡丹
夏修龙
张超
魏添添
刘晓云
ZHANG Baisong;HU Dan;XIA Xiulong;ZHANG Chao;WEI Tiantian;LIU Xiaoyun(School of Public Health,Peking University,Beijing 100191,China;China Center for Health Development Studies,Peking University,Beijing 100191,China;Jiujiang University Medical Center,Jiujiang 332005,China)
出处
《中国全科医学》
CAS
北大核心
2022年第22期2698-2705,共8页
Chinese General Practice
基金
美国中华医学基金会项目(CMB 18-294)。
关键词
全科医生
订单定向医学生
教育
医学
卫生政策
初级卫生保健
综述
General practitioners
Target admissionmedical graduates
Education,medical
Health policy
Primary health care
Review
作者简介
通信作者:胡丹,副研究员,E-mail:hudan@bjmu.edu.cn。
